She was formerly a Postdoctoral Researcher at NYU’s Institute for Public Knowledge and holds a Ph.D. in Communication from the USC Annenberg School for Communication and Journalism.
Sherman applied the “Page 99 Test” to her new book, How We Hurt: The Politics of Pain in the Opioid Epidemic, and reported the following:
From page 99:Visit Melina Sherman's website.Though this concept [pseudoaddiction] has since been widely disputed in pain management, it is still listed as an “up-to-date” concept under the umbrella of opioid addiction as defined by the Federation of State Medical Boards (Chabal et al., 1998; Greene & Chambers, 2015; Dowell et al., 2013; Vijayaraghavan et al., 2013). In recent years, however, the concept of pseudoaddiction has come under fire for the role it is seen as having played in the upsurges of long-term prescription opioid use that many consider to be the driving force of the opioid epidemic, at least initially. In media accounts of the epidemic, pseudoaddiction is often pointed to as a convenient and disingenuous answer invented by big pharma sympathizers for the many physicians who saw in their pain patients the symptoms of growing tolerance and, in some cases, opioid withdrawal (e.g., Deprez & Barrett, 2017; Kessler, 2017; Radden Keefe, 2017). A concept like pseudoaddiction—especially when presented in the pages of a respected medical journal—also works to legitimate long-term opioid prescribing and encourage the continued sale of opioid products, particularly in cases where it is unclear whether the pain patient’s relationship to that product has soured.If you opened How We Hurt to page 99, it’s likely that you would get a good idea of several key concepts that are central to the entire text. First, you would get an overview of “pseudoaddiction,” an infamous yet widely debunked concept invented by David Haddox to help physicians distinguish pain “patients” from opioid “addicts.” Though Haddox’s intentions coining this concept may have been pure, and though the concept itself may have even been useful to certain gatekeepers of opioids, it’s also the case that Haddox was employed by one of the biggest opioid manufacturers, Purdue Pharma, to promote the concept (and Purdue’s drugs) and that pseudoaddiction appeared to many as an all-too-convenient way of encouraging all patients, regardless of their relationships with opioids, to continue taking these medications. Underlying the question of pseudoaddiction are many of the issues that are central to the opioid crisis as a whole. We see embedded in this concept the deep ties between science and the pharmaceutical industry and the thorny relationship of these two fields that is always at play where opioids are concerned. We also see confusion, and uncertainty – two phenomena which have plagued nearly every major stakeholder in the opioid industrial complex, and which laid fertile ground for the crisis we are currently attempting to manage. Finally, in pseudoaddiction we also see an attempt, repeatedly made by scientists, physicians, pharma reps, regulators, and others, to draw a line that separates opioid patients from opioid addicts. Though, as my book shows, this line is fuzzy at best, the insistence of so many stakeholders to render it more concrete has also shaped the opioid crisis and made it look the way it does today. Ultimately, then, I’d say that while page 99 does not exactly describe the entire book, it does lay down some of the most important ideas that are espoused within it and sets the stage for the more in-depth analyses contained in each of its chapters.
Moreover, it is not insignificant that one of the authors of the paper that introduced the pseudoaddiction concept, Dr. David Haddox, signed on as a paid speaker for OxyContin-maker Purdue Pharma shortly after the article’s publication. Haddox has since been promoted to the company’s vice president of health policy and has been paid to travel all over the country and give talks that simultaneously spread the word about pseudoaddiction and promote Purdue’s latest opioid products. Moreover, pseudoaddiction has also made frequent appearances in the marketing materials Purdue released in its promotion of OxyContin, including in educational pamphlets designed to provide physicians and patients with reliable information about the safety of opioids and in the “I Got My Life Back” videos. Thus, while it would be difficult to say, unconditionally, that the understanding of addiction espoused in the concept of pseudoaddiction led to the opioid epidemic, it is certainly the case that such an understanding complemented the interests of the opioid industry, just as it complemented the interests of physicians (most of whom were well intentioned and simply wanted to help their patients find relief) and pain patients (nearly all or all of whom want to be pain free).
--Marshal Zeringue
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